Preclinical teaching of periodontal surgical concepts using common instructional models: A comparative assessment.

OBJECTIVES: Some commonly used models utilized for teaching periodontal surgical techniques to dental students include pig mandible and periodontal typodonts. Currently, no study compares the learning and teaching outcomes following the use of one model to the other. This study is aimed at evaluating the effectiveness of the preclinical laboratory component on student understanding of concepts taught in the periodontal surgical course and assessing students' and faculty members' satisfaction with the instructional models. METHODS: As part of the surgical periodontics course, 98 students took the final exam, with eighty students participating in only the pig mandible session and twenty-three students participating in both the pig jaw mandible and an additional session utilizing periodontal typodonts under the supervision of ten periodontal faculty members. Examination scores of students attending or not attending the laboratory session were analyzed by a two-sample t-test. A questionnaire evaluating the effectiveness of both models was given to faculty members and students who participated in both laboratory sessions. These results were analyzed by paired t-test. RESULTS: Participation in the laboratory sessions did not significantly impact the final exam scores (p = 0.722). Students who had better didactic performance in the course performed better in the final exam, irrespective of laboratory participation. Both students and faculty members preferred typodont to the pig mandibles in learning or teaching periodontal surgical concepts, but both felt gaining flap management and flap refection experience to be better with the pig mandible model without statistical significance (p = 0.119 and p = 0.070, respectively). CONCLUSION: Within the limitations of this study, we can conclude that laboratory sessions did not significantly improve student performance on the exam. Students and faculty members generally gave positive feedback on both instructional models. Periodontal typodont could be an alternative model for teaching dental students, periodontal surgical concepts.

TASTE DISORDERS AND XEROSTOMIA ARE HIGHLY PREVALENT IN PATIENTS WITH COVID-19.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: J. Amorim dos Santos, A.G.C. Normando, R.L.Carvalho da Silva, A.C. Acevedo G. De Luca Canto, N. Sugaya, A.R. Santos-Silva , E.N.S. Guerra (2021). ``Oral Manifestations in Patients with COVID-19: A Living Systematic Review.'' J Dent Res 100(2): 141-154. SOURCE OF FUNDING: Non-profit, Foundations, etc.? National Council for Scientific and Technological Development, Ministry of Education, Brazil and the Department of Research and Innovation, University of Brasilia, Brazil. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data.

Treatment of Select Intrabony Defects by Periodontal Regeneration Could Be Cost-effective Long Term in Compliant Patients.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Periodontal regeneration compared with access flap surgery in human intrabony defects: 20-year follow-up of a randomized clinical trial: tooth regeneration, periodontitis recurrence and costs. Cortellini P, Buti J, Prato GP, Tonetti MS.J Clin Periodontolhttp://dx.doi.org/10.1111/jcpe.12638 [Pre pub/accepted manuscript] SOURCE OF FUNDING: Nonprofit, foundations: European Research Group on Periodontology, Genova, Italy; other: Accademia Toscana di Ricerca Odontostomatologica, Florence, Italy TYPE OF STUDY/DESIGN: Randomized controlled trial.

A Risk of Bias Assessment of Randomized Controlled Trials (RCTs) on Periodontal Regeneration Published in 2013.

OBJECTIVE: The objective of this assessment is to evaluate the degree of risk of bias in randomized controlled trials published in 2013 and focusing on periodontal regeneration. METHODS: Three reviewers searched and selected the trials based on pre-defined inclusion criteria. Predictor variables [number of authors, primary objective of the study, biomaterial employed, follow-up time periods, split mouth study (yes/no), journal, year of publication, country, scale (single/multi-center) and nature of funding] were extracted and risk of bias assessment using Cochrane risk of bias tool were performed independently by the three reviewers. RESULTS: Seventeen RCTs were included in this assessment. The risk of bias in RCTs published in 2013 with a focus in periodontal regeneration varied significantly with only in less than 30% of the included trials, the overall risk of bias was found to be low, while 41% of trials were designated to have a higher degree of bias. Specifically, when looking at the domains assessed, 70% of the included trials reported an accepted method of sequence generation, blinding (whenever possible), completeness of outcome data or avoided selective outcome reporting. Meanwhile, only 47% of the included trials reported some form of allocation concealment. CONCLUSION: In this assessment, of the included 17 trials, slightly more than 40% of them had a high risk of bias, underscoring the importance of careful appraisal of trials before implementing the study interventions in clinical practice and the need for more detailed analyses.

Usage of Bone Replacement Grafts in Periodontics and Oral Implantology and Their Current Levels of Clinical Evidence - A Systematic Assessment.

BACKGROUND: The aim of this review is to evaluate the levels of clinical evidence for bone replacement grafts available in the United States for periodontics and oral implantology purposes. METHODS: A search was performed using PubMed, the Cochrane Library, and Google Scholar for articles relating to the use of bone replacement grafts in implant and/or periodontics by two independent reviewers. Articles unrelated to the topic, not involving patients, not including abstracts, or in languages other than English were excluded. Selected articles were graded according to "levels of evidence" based on guidelines originally introduced by Wright et al. (2003). RESULTS: There was limited published peer-reviewed clinical literature available regarding US commercially available bone replacement grafts in periodontics and oral implantology. Of 144 bone replacement grafts available in the United States according to Avila-Ortiz et al. (2013), only 52 met the inclusion criteria. The majority of materials used were allografts (26 of 93 available in the United States), followed by alloplasts (15 of 30) and xenografts (11 of 21). CONCLUSION: Dental providers should be aware of the limited evidence that qualified for a strong rating supporting the clinical efficacy of these materials for periodontics and oral implantology purposes using the inclusion criteria selected in this study.

Global Dental Research Productivity and Its Association With Human Development, Gross National Income, and Political Stability.

OBJECTIVE: The objective of this study is to examine the associations between country level factors (such as human development, economic productivity, and political stability) and their dental research productivity. METHODS: This study is a cross-sectional analysis of bibliometric data from Scopus search engine. Human Development Index (HDI), Gross National Income per capita (GNI), and Failed State Index measures were the independent variables. Outcomes were "Total number of publications (articles or articles in press) in the field of dentistry" and "Total number of publications in the field of dentistry per million population." Non-parametric tests were used to examine the association between the independent and outcome variables. RESULTS: During the year 2013, a total of 11,952 dental research articles were published across the world. The top 5 publishing countries were United States, Brazil, India, Japan, and United Kingdom. "Very High" HDI countries had significantly higher number of total dental research articles and dental research articles per million population when compared to the "High HDI," "Medium HDI," and "Low HDI" countries (p < 0.0001). There was a significant linear relationship between the GNI quartile income levels and outcome metrics (p ≤ 0.007). Countries which were highly politically stable were associated with significantly higher dental research productivity (p < 0.0001). CONCLUSIONS: There appears to be a regional concentration of articles with just five countries contributing to over 50% of all articles. The human development and economic development of a country are linearly correlated with dental research productivity. Dental research productivity also increases with increasing political stability of a country.

Presence of gingivitis and periodontitis significantly increases hospital charges in patients undergoing heart valve surgery.

OBJECTIVE: To examine the prevalence and impact of gingivitis and periodontitis in patients having heart valve surgical procedures. METHODS: Nationwide Inpatient Sample for the years 2004-2010 was used. All patients who had heart valve surgical procedures were selected. Prevalence of gingivitis/periodontitis was examined in these patients. Impact of gingivitis/periodontitis on hospital charges, length of stay, and infectious complications was examined. RESULTS: 596,190 patients had heart valve surgical procedures. Gingivitis/periodontitis was present in 0.2 percent. Outcomes included: median hospital charges ($175,418 with gingivitis/ periodontitis versus $149,353 without gingivitis/periodontitis) and median length of stay (14 days with gingivitis/periodontitis versus 8 days without gingivitis/periodontitis). After adjusting for the effects of patient- and hospital-level confounding factors, hospital charges and length of stay were significantly higher (p < 0.001) in those with gingivitis/periodontitis compared to their counterparts. Further, patients with gingivitis/periodontitis had significantly higher odds for having bacterial infections (OR = 3.41, 95% CI = 2.33-4.98, p < 0.0001) when compared to those without gingivitis/periodontitis. CONCLUSION: Presence of gingivitis and periodontitis is associated with higher risk for bacterial infections and significant hospital resource utilization.

A cross-sectional assessment of biomarker levels around implants versus natural teeth in periodontal maintenance patients.

BACKGROUND: Recent studies point to the clinical utility of using peri-implant sulcular fluid (PISF) as a valuable diagnostic aid for monitoring peri-implant tissue health. The objectives of this study are to determine the levels of key biomarkers in PISF in periodontal maintenance participants and compare them with their corresponding levels in gingival crevicular fluid (GCF) obtained from the same participants. METHODS: PISF and GCF were collected from an implant and a contralateral natural tooth after the clinical examination of 73 participants. The levels of interleukin (IL)-1α, IL-1ß, IL-6, IL-8, IL-10, IL-12, IL-17A, tumor necrosis factor (TNF)-α, C-reactive protein, osteoprotegerin, leptin, and adiponectin were determined using multiplex proteomic immunoassays. The correlation of biomarker concentrations between GCF versus PISF, within GCF or PISF, and with several covariates (age, brushing frequency, days since professional cleaning, probing depth [PD], and plaque index) were also determined. RESULTS: Significantly higher levels of IL-17A (P = 0.02) and TNF-α (P = 0.03) were noted in PISF when compared with their levels in GCF. Significant positive correlations were noted between the concentrations of cytokines in PISF versus their levels in GCF. Among the covariates, a significant positive correlation was noted between mean PDs around implants and levels of IL-1ß (P <0.05) and IL-8 (P <0.05) in PISF. CONCLUSION: The results of this study point to the differential expression of specific biomarkers in GCF versus their levels in PISF in periodontal maintenance patients, which is critical information before establishing PISF as a diagnostic fluid to monitor peri-implant health.

Pathways for foreign-trained dentists to pursue careers in the United States.

With the U.S. population growing ever more diverse and the need for dentists in many areas of the United States, there is increasing opportunity for foreign-trained dentists to pursue dental careers in this country. This article provides a broad overview of dental education and career pathways available for foreign-trained dentists in the United States. Educational opportunities include pursuing advanced standing dental degree programs and advanced graduate education (residency programs). Career pathways include working in academic and private practice settings. This article also describes the licensure and visa requirements foreign-trained dentists must satisfy to work legally in the United States.

An overview of characteristics of registered studies on dental implants.

OBJECTIVE: Clinical trials serve as the empirical basis for clinical decision making. The objective of the current study is to provide an overview of clinical trials examining dental implant outcomes. METHOD: All registered studies on Dental Implants were selected for analysis. The clinicaltrials.gov website was used to query the characteristics of registered studies. The search term used was dental implants. RESULTS: As of the study conduct date (01/01/2014), a total of 205 studies on dental implants were registered. These included 168 interventional and 37 observational studies. Results were available for only 14 studies. All observational studies and 98.8% of interventional studies included both male and female subjects. Close to 60% of studies had sample sizes between 1 and 50. NIH was listed as funding source in only 5 interventional studies and 3 observational studies. 80% of interventional studies were randomized. However, double masking was reported in only 15% of interventional studies with majority being open labeled. CONCLUSION: ClinicalTrials.gov registry was created with the intention of increasing the transparency of conducted or ongoing clinical studies and to minimize publication bias commonly seen with industry-sponsored studies. Results of the current study showed that a predominating number of registered studies are funded by industry and other sources, very few registered studies have made their results public, and the ClinicalTrials.gov registry does not provide sufficient information on the quality of study design and thus precluding the public and researchers to judge on the quality of registered studies and publication bias.

Quality assessment of systematic reviews on alveolar ridge preservation.

BACKGROUND: The authors conducted a study to assess the quality of systematic reviews (SRs) published on the topic of alveolar ridge preservation (ARP). TYPES OF STUDIES REVIEWED: The authors conducted a search for SRs on ARP on the basis of a set of eligibility criteria (only SRs involving ARP, with or without meta-analyses, written in English). The authors assessed the quality of the SRs independently of one another by using two established checklists. RESULTS: The authors selected eight SRs. The results of all of the SRs indicated that ARP was effective in preserving the ridge volume as compared with extraction alone, but it did not fully prevent bone-resorptive events. None of the SRs, however, received the highest possible score in either of the checklists. One SR that had a score of 5 (of a possible 11) using one checklist and 5 (of a possible 14) using the other checklist had the lowest overall score. The results of this assessment revealed that a significant proportion of the investigators in the SRs did not include non-English language articles, perform hand searching of published literature or evaluate the gray literature. Assessment of publication bias and reporting of conflicts of interest also was lacking in some studies. Practical Implications. Although ARP appears to be an effective approach to preventing resorption after tooth extraction, significant structural and methodological variability exists among SRs on this topic. Future SRs on ARP should consider the use of quality assessment checklists to minimize methodological shortcomings for better dissemination of scientific evidence.

The association between periodontitis and coronary heart disease: a quality assessment of systematic reviews.

BACKGROUND: The existence of an association between periodontitis and cardiovascular disease has been proposed by investigators in several clinical studies and further confirmed by the results of several systematic reviews. The aim of the authors' study was to assess the quality of published systematic reviews focused on the association between periodontitis and coronary heart disease (CHD) by using established systematic review assessment checklists. METHODS: Two reviewers conducted a search for systematic reviews focusing on the association between periodontitis and CHD. Three independent reviewers appraised the quality of the selected 13 reviews by using an established and validated assessment tool for systematic reviews and another checklist. They gave each article a total score according to the number of criteria on each checklist that the article fulfilled. RESULTS: Nine reviews satisfied six or more items on the assessment tool, whereas two reviews each satisfied only one item. This assessment shows that published systematic reviews of the periodontitis-CHD association exhibit significant structural and methodological variation, which the authors further confirmed by using the second checklist. CONCLUSION: Systematic reviews of the association between periodontitis and CHD exhibited significant differences in their methodological quality. PRACTICAL IMPLICATIONS: Clinicians should be aware that not all systematic reviews of the periodontitis-CHD association are conducted in a rigorous manner and should be capable of differentiating well-conducted reviews from poorly conducted ones.

Quality assessment of systematic reviews on short dental implants.

BACKGROUND: Critical analysis of published systematic reviews may help in understanding their strengths and weaknesses and identifying areas that need improvement. Short dental implants are becoming an important addition to the existing dental armamentarium. The aim of this overview is to analyze the quality of published systematic reviews focused on short dental implants using established checklists such as the assessment of multiple systematic reviews (AMSTAR). METHODS: A search was conducted to retrieve reviews that used a systematic approach in article selection focusing on short dental implants in humans. Based on a set of inclusion and exclusion criteria, a total of 10 reviews were selected. Two independent reviewers appraised the quality of the selected reviews using AMSTAR and the checklist proposed by Glenny et al. in 2003. Each article was given a total score based on the number of criteria that it fulfilled. RESULTS: Six reviews satisfied ≤4 of the 11 AMSTAR items, and only two reviews satisfied nine of the 11 items. This study shows that published systematic reviews on short dental implants exhibit significant structural and methodological variability. Quality assessment using the Glenny checklist further confirmed the variability in the way systematic reviews were conducted and/or reported. A high correlation was observed between the two checklists' scores. CONCLUSIONS: Uniformity in the way systematic reviews are conducted and/or reported will increase the validity and clinical applicability of future reviews.

Quality assessment of systematic reviews on periodontal regeneration in humans.

BACKGROUND: Systematic reviews represent the highest form of evidence in the current hierarchy of evidence-based dentistry. Critical analysis of published systematic reviews may help to analyze their strengths and weaknesses and to identify areas that need future improvement. The aim of this overview is to determine and compare the quality of systematic reviews published in the field of periodontal regeneration using established checklists, such as the Assessment of Multiple Systematic Reviews (AMSTAR) guidelines. METHODS: A systematic search was conducted to retrieve reviews on periodontal regeneration in humans. A total of 14 systematic reviews were selected using a set of inclusion and exclusion criteria. Two independent reviewers appraised the quality of the selected reviews using AMSTAR guidelines. Each article was given an AMSTAR total score, based on the number of AMSTAR criteria that were fulfilled. The quality of included reviews was further assessed using a checklist proposed in 2003. RESULTS: Only one of the selected systematic reviews satisfied all the AMSTAR guidelines, whereas two reviews satisfied just two of the 11 items. This study shows that published systematic reviews on periodontal regeneration exhibit significant structural and methodologic variability. Quality assessment using the additional checklist further confirmed the variability in the way systematic reviews were conducted and/or reported. CONCLUSION: Consideration of guidelines for quality assessment, such as AMSTAR, when designing and conducting systematic reviews may increase the validity and clinical applicability of future reviews.

Hospital-based emergency department visits with oral candidiasis in the USA.

OBJECTIVES: The aim of this study was to determine the number of hospital Emergency Department (ED) visits with a diagnosis of oral candidiasis for the year 2007 in the USA and to identify the comorbid conditions associated with it. STUDY DESIGN: The Nationwide Emergency Department Sample (NEDS) for 2007 was employed in this study. Patients who visited the ED with a diagnosis of oral candidiasis were selected, and the estimates were projected to the national levels using the discharge weights. Presence of comorbid conditions in these patients was also determined. RESULTS: A total of 249,092 ED visits had oral candidiasis. Most of the patients belonged to the lower socioeconomic strata. Patients presented with a wide range of comorbid conditions and a large percentage of the patients were subsequently hospitalized after ED visits. CONCLUSIONS: A significant number of patients in the US visited the ED with oral candidiasis in the year 2007.

Hospital-based emergency department visits with herpetic gingivostomatitis in the United States.

OBJECTIVES: The objectives of this study were to determine the number of hospital emergency department (ED) visits with a diagnosis of herpetic gingivostomatitis (HGS) for 2007 in the United States and to identify the possible comorbid conditions associated with HGS. STUDY DESIGN: The Nationwide Emergency Department Sample for 2007 was used in this study. Patients who visited the ED with a diagnosis of HGS were selected. Estimates were projected to the national levels using the discharge weights. Presence of comorbid conditions in these patients was also analyzed. RESULTS: A total of 23,124 patients had ED visits and received the diagnosis of HGS. Most of the patients were young females and those belonging to the lower socioeconomic strata. All patients with HGS also presented with comorbid conditions. CONCLUSIONS: Physicians should be trained to diagnose, manage, and refer common dental emergencies. In the long term, improving access to dental care for these patients is crucial to managing this problem.

Prevalence and impact of complications on outcomes in patients hospitalized for oral and oropharyngeal cancer treatment.

OBJECTIVE: We studied the association between presence of complications and hospitalization outcomes, including hospital charges, length of stay in hospital, and in-hospital mortality. METHODS: The Nationwide Inpatient Sample for 2008 was used. All hospital discharges with a primary diagnosis of oral and oropharyngeal cancers were selected. Presence of complications was determined by using ICD-9-CM codes. The association between the presence of complications and outcomes (hospital charges, length of stay, and in-hospital mortality) was examined by multivariable linear and multivariable logistic regression analyses. The effects of several patient- and hospital-related confounders were adjusted in the regression analyses. RESULTS: A total of 17,632 hospitalizations were attributed to oral and oropharyngeal cancers. A total of 519 (2.9%) patients died in the hospitals. The total hospitalization charges were close to $1.08 billion. Oral and oropharyngeal cancers accounted for 117,472 hospitalization days (mean length of stay 6.6 days). The overall complication rate was 14.95%. The most frequently present complication was hemorrhagic complications. Among the different complications, septicemia was associated with the worst outcomes. Patients with septicemia were associated with the highest odds for in-hospital mortality (OR = 13.06, 95% CI = 3.81-48.50, P = .0001). CONCLUSIONS: Presence of complications was associated with poor outcomes, such as high in-hospital mortality rates, excess hospitalization charges, and longer length of stay in hospital. Among the different complications, septicemia was associated with the worst outcomes.

Hospital emergency department visits attributed to pulpal and periapical disease in the United States in 2006.

BACKGROUND: Relatively localized conditions such as infection of the pulp or periapical tissues if left untreated could spread and require hospital care. The objectives of this study were to assess the prevalence of such hospital-based emergency department (ED) visits, to quantify hospital charges associated with those visits, and to identify characteristics of those members of the population who are likely to make such visits. METHODS: The experimental design of this study involves the use of The Nationwide Emergency Department Sample for the year 2006. All discharges with a primary diagnosis code for pulpal and periapical diseases (International Classification of Disease, Clinical Modification [ICD-9-CM] code of 522) were selected for analysis. All estimates were projected to national levels using the discharge weight variables. RESULTS: In the United States, during the year 2006, a total of 403,149 ED visits had a primary diagnosis code for pulp and periapical diseases. The average patient age was 32.9 years. The mean hospital charge for ED visits was $480, and the total charges for all the ED visits in the United States was $163,692,957. Among the ED visits, 5,721 were admitted to the same hospital for inpatient care. The mean length of stay after hospitalization was 2.95 days. The uninsured (39.92%) constituted the largest proportion of all ED visits. CONCLUSIONS: This study identifies high-risk groups that are likely to present to hospital-based EDs for the treatment of pulp and periapical diseases. This highlights the need for significant resources to treat such patients in a hospital care setting.

Outcomes in patients visiting hospital emergency departments in the United States because of periodontal conditions.

BACKGROUND: The chances of presenting to hospital emergency departments (EDs) are significantly higher in individuals who ignore regular dental care and in those with medical conditions. Little is known about nationwide estimates of hospital-based ED visits caused by periodontal conditions in the United States. The objective of this study is to determine the incidence of ED visits caused by periodontal conditions that occurred in a 2006 nationwide sample and to identify the risk factors for hospitalization during the ED visits. METHODS: The Nationwide Emergency Department Sample (NEDS) for 2006 was used for this study. Patients who visited the ED with a primary diagnosis of acute gingivitis, chronic gingivitis, gingival recession, aggressive or acute periodontitis, chronic periodontitis, periodontosis, accretions, other specified periodontal disease, or unspecified gingival and periodontal disease were selected for this study. Estimates were projected to the national levels using the discharge weights. The association between patient characteristics and the odds of being hospitalized was examined using a multivariable logistic regression analysis. RESULTS: A total of 85,039 visits to hospital-based EDs with a mean charge per visit of $456.31 and total charges close to $33.3 million were primarily attributed to gingival and periodontal conditions in the United States. Close to 36% and 33% of all visits occurred among the lowest income group and uninsured population, respectively. The total ED charges for those covered by Medicare, Medicaid, private insurance, and other insurance plans were close to $4.95 million, $9.14 million, $8.01 million, and $0.92 million, respectively. The uninsured were charged a total of $10.06 million. Inpatient admission to the same hospital was required for 1,167 visits. The total hospitalization charge for this group was $17.51 million. Patients with comorbid conditions (congestive heart failure, valvular disease, hypertension, paralysis, neurologic disorders, chronic pulmonary disease, hypothyroidism, liver disease, AIDS, coagulopathy, deficiency anemia, obesity, alcohol abuse, or drug abuse) were associated with higher odds for hospitalization during an ED visit for periodontal conditions compared to those without comorbid conditions (P <0.05). Patients who had a primary diagnosis of acute or aggressive periodontitis were associated with significantly higher odds of being hospitalized during ED visits. CONCLUSIONS: Estimates from the NEDS suggest that a total of 85,039 hospital-based ED visits had a primary diagnosis for periodontal conditions. Close to $33.3 million was charged by hospitals for treating these conditions on an emergency basis. ED visits with a primary diagnosis for acute and aggressive periodontitis, covered by Medicare insurance, and comorbid conditions were more likely to result in hospitalization based on the analysis of the NEDS. However, when interpreting these conclusions, one should keep the limitations inherent to hospital discharge datasets in perspective.